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    Original Investigation
    July 28, 2020

    Association of Media Coverage of Transgender and Gender Diverse Issues With Rates of Referral of Transgender Children and Adolescents to Specialist Gender Clinics in the UK and Australia

    Author Affiliations
    • 1Department of Adolescent Medicine, Royal Children’s Hospital, Parkville, Australia
    • 2Clinical Sciences Theme, Murdoch Children’s Research Institute, Parkville, Australia
    • 3Department of Paediatrics, The University of Melbourne, Parkville, Australia
    • 4Inflammation Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
    • 5Gender Identity Development Service, Tavistock and Portman NHS Foundation Trust, London, United Kingdom
    • 6Department of Medical Psychology, Amsterdam UMC, Amsterdam, the Netherlands
    • 7Center of Expertise on Gender Dysphoria, Amsterdam UMC, Amsterdam, the Netherlands
    • 8Sloan School of Management, Massachusetts Institute of Technology, Cambridge
    JAMA Netw Open. 2020;3(7):e2011161. doi:10.1001/jamanetworkopen.2020.11161
    Key Points español 中文 (chinese)

    Question  Is media coverage of transgender issues associated with referrals of transgender and gender diverse (TGD) children and adolescents to specialist gender services?

    Findings  In this serial cross-sectional study across an 8-year study period during which more than 5000 TGD young people were referred to 2 pediatric gender clinics in the UK and Australia, a significant association was found between weekly referral rates and the number of TGD-related items appearing within the local media 1 to 2 weeks beforehand, for the UK only in week 1 and for Australia only in week 2.

    Meaning  An increase in media coverage of TGD-related topics over recent years was associated with an increase in the number of TGD young people presenting to 2 gender clinics on opposite sides of the world.


    Importance  Specialist gender clinics worldwide have witnessed an increase in referrals of transgender and gender diverse (TGD) children and adolescents, but the underlying factors associated with this increase are unknown.

    Objective  To determine whether increases in TGD young people presenting to specialist gender clinics are associated with related media coverage.

    Design, Setting, and Participants  This cross-sectional study was conducted at 2 publicly funded, pediatric specialist gender services, one located in the UK and the other in Australia. Participants were all children and adolescents aged 0 to 18 years, referred between January 1, 2009, and December 31, 2016, to their respective gender services in the UK and Australia. Data analysis was performed in April 2019.

    Exposures  Media coverage of TGD issues.

    Main Outcomes and Measures  Referral rates from each gender service were compared with local TGD-related media coverage during the study period.

    Results  Referral data for 5242 TGD young people were obtained (4684 in the UK, of whom 1847 [39.4%] were assigned male at birth and 2837 [60.6%] were assigned female at birth; 558 in Australia, of whom 250 [44.8%] were assigned male at birth and 308 [55.2%] were assigned female at birth), and a total of 2614 news items were identified (UK, 2194; Australia, 420). The annual number of TGD young people referred to both specialist gender clinics was positively correlated with the number of TGD-related local media stories appearing each year (Spearman r = 1.0; P < .001). Moreover, weekly referral rates in both the UK for week 1 (β̂ = 0.16; 95% CI, 0.03-0.29; P = .01) and Australia for week 2 (β̂ = 0.12; 95% CI, 0.04-0.20; P = .003) showed evidence of association with the number of TGD-related media items appearing within the local media. There was no evidence of association between referrals and media items appearing 3 weeks beforehand. Media predominantly focused on TGD issues showed some association with increased referral rates. Specifically, TGD-focused stories showed evidence of association with referral numbers at week 1 (β̂ = 0.16; 95% CI, 0.04-0.28; P = .007) and week 2 (β̂ = 0.23; 95% CI, 0.11-0.35; P < .001) in Australia and with referral numbers at week 1 (β̂ = 0.22; 95% CI, 0.01-0.44; P = .04) in the UK. No evidence of association was found between media peripherally related to TGD issues and referral rates.

    Conclusions and Relevance  This study found evidence of an association between increasing media coverage of TGD-related topics and increasing numbers of young people presenting to gender clinics. It is possible that media coverage acts as a precipitant for young people to seek treatment at specialist gender services, which is consistent with clinical experiences in which TGD young people commonly identify the media as a helpful source of information and a trigger to seek assistance.